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4 Strategies to Dramatically Reduce Bloodstream Infections in the NICU
Healthcare-associated infections are significant contributors to morbidity and mortality in the neonatal intensive care unit (NICU). Across all birth weight groups, bloodstream infections (BSIs) are the most common type of infection acquired by infants . Bloodstream infections are a care-related complication that are entirely preventable. Reducing and preventing the occurrence of bloodstream infections is an important safety goal for level 3 and level 4 NICUs around the country. Here are 4 simple strategies proven to substantially lower the incidence of BSIs among neonates [2, 3, 4, 5].
Closed Medication Systems for NICU Infusion
Aseptic precautions during the management of intravenous lines in newborn infants can result in a dramatic reduction in bloodstream infections. A study at the George Washington University Hospital demonstrated that the use of a closed medication system reduced the incidence of BSIs from approximately 25 percent to 2 percent. The use of closed NICU infusion systems also brought down the culture-proven sepsis rate among very low birth weight infants (<1500 g) from about 46 percent to 5 percent.
Registered Nurse Staffing
There is evidence showing a considerable association between nurse staffing and patient outcomes in the NICU. A large cohort study of 2,675 NICU admissions  in New York found that increasing the number of hours of care provided by registered nurses was associated with a significant decrease in the risk of bloodstream infections. Increased nursing intensity resulted in a 79 percent reduction in the risk of BSIs. A greater number of registered nurse hours also improved survival rates.
A dramatic improvement in neonatal CLABSI rates can be achieved with chlorhexidine skin asepsis, among other measures. Eight diverse NICUs around the United States participated in an experimental study to identify interventions that could reduce bloodstream infections in infants . A substantially reduced incidence of BSIs was achieved and sustained for several years. Although the success could not be attributed to any single intervention, the standardized use of chlorhexidine-impregnated discs was believed to be a significant contributor.
Several hygiene practice changes, including hand washing initiatives, clean gloves before central line manipulations, and cleaning of patient areas during each shift have been found to improve BSI rates. These and other measures were studied by reviewing care data on the outcomes of 6,790 infants admitted to the Duke University Medical Center NICU between 2005 and 2013 . The institution recorded a 92 percent decrease in BSI incidence as a result of changes in hygiene practices.
An increased incidence of BSIs in a NICU can be the result of various factors, such as excessive manipulation of central line catheters, understaffing, overcrowding, and inadequate antiseptic precautions and hygiene practices. Targeted interventions and concerted efforts from the nursing team can help achieve sustained success in bloodstream infection reduction.
Find out more about closed medication systems and how they can help reduce the incidence of bloodstream infections in your NICU.